# Gender Disparities in Trauma Patients With an Elevated Shock Index at a Rural Appalachian Trauma Center

## TL;DR

This study finds that male trauma patients with a high shock index have worse outcomes and longer hospital stays compared to females in a rural trauma center.

## Contribution

The study highlights gender disparities in trauma outcomes using shock index in a rural Appalachian setting.

## Key findings

- Males with a shock index ≥1.0 had longer hospital stays and higher mortality rates than females.
- Males were more likely to die and require blood transfusions compared to females.
- Males were more likely to have motorcycle accidents, while females were more likely to have falls or motor vehicle collisions.

## Abstract

Introduction: Although men are more likely to experience a traumatic injury, research demonstrates that gender may impact patients’ biological responses to trauma. Shock index (SI) is a validated tool used to predict patient outcomes. This study aims to determine if gender is associated with differences in outcomes in patients with an SI ≥1.0 in the rural setting.

Methods: This retrospective study included 699 trauma patients with an SI ≥1.0 admitted to a rural trauma center from January 2017 to December 2022. Student’s t-test, chi-square analysis, and univariate logistic regression were used to analyze the study data. Primary outcomes included mortality and blood transfusions. Secondary outcomes included discharge to a care facility, hospital days, ICU days, and ventilator days.

Results: Males with a SI ≥1.0 had a significantly longer length of stay (LOS) (7.0 ± 7.4 vs. 5.8 ± 6.7, P = 0.039), had a higher injury severity score (14.5 ± 12.2 vs. 10.4 ± 10.1, P < 0.001), were x1.99 more likely to die (OR = 1.999, 95% CI = 0.213-1.171, P = 0.005), and were x1.7 more likely to require blood transfusion (OR = 1.700, 95% CI = 0.323-0.937, P = 0.002) than females. Males were 4.4 times more likely to have a motorcycle accident (OR = 4.4, 95% CI = 1.935-9.816, P < 0.001). Females were 1.5 times more likely to have a fall (OR = 1.5, 95% CI = 1.099-2.146, P = 0.012) and 1.6 times more likely to have an MVC (OR = 1.6, 95% CI = 1.141-2.175, P = 0.006).

Conclusion: These findings emphasize a gender disparity in trauma patients with an SI ≥1.0 at this study’s rural institution. This study adds to the literature on SI and gender disparities.